CYTOMEGALOVIRUS AS A COFACTOR IN TRANSMISSION AND PROGRESSION OF PERINATAL HIV-INFECTION

We retrospectively studied a cohort of children with HIV infection to identify those children with cytomegalovirus (CMV) infection. CMV infe ction was defined as a positive culture for CMV from urine, throat, or biopsy specimen, or a positive serologic assay for IgG antibody in ch ildren greater than 6 months of age. Twenty-five (64%) of 39 HIV-infec ted children were infected with CMV; 22 (88%) were positive on first c ulture or serologic assay; 15 (60%) had CMV infection documented prior to their first birthdays. We compared the cumulative prevalence of CM V in HIV-infected children (P1 and P2), seroreverters (P3), and in age -matched HIV-negative controls. Prevalence of CMV infection in HIV-inf ected children was not significantly different from that in HIV-negati ve children (25/39 vs. 18/49, p = .07). Seroreverters were less freque ntly infected with CMV than HIV-infected children (2/26 vs. 25/39, p < .001). HIV-infected children who were also infected with CMV were mor e likely to have severe encephalopathy, elevated hepatic enzymes assoc iated with zidovudine (AZT) administration, and suffer death. CMV dise ase was identified in 5 HIV-infected children, all with acquisition of CMV early in life. We conclude that CMV infection occurs in the major ity of HIV-infected children in our population and adversely affects s urvival. Most CMV-infected children were infected at initial evaluatio n, suggesting acquisition early in life.